From PACS to integrated EMR.

The integration of medical images as part of the patient record has always been a critical component of documentation and information supporting clinical decisions. In the past two decades the increased number of imaging procedures that allows a more accurate and more specific diagnosis has significantly increased and their role in patient management has grown rapidly. With the evolution toward digital modalities and management of medical images in a fully digital environment with the deployment of enterprise wide Picture Archiving Communication Systems (PACS) a wider and more rapid access to the images by referring physicians and clinicians has become possible. The parallel evolution of electronic medical records (EMR) supporting all other documents and clinical data in electronic format led to the necessity of integrating medial image data with the rest of the patient record. Although the marriage of medical images and patient record data in electronic format seems a very natural and necessary combination it has often been very slow in development due to the lack of standardization and clear understanding of clinical workflows and clinical requirements. Several early implementations demonstrated the added value of combining medical images with the patient record and have shown that the availability of data and images facilitates and improves the accuracy and efficiency of patient management. Recent efforts in industry and the academic community to harmonize and improve the integration of medical images with patient record, with the promotion of new standards and better definitions of clinical workflows and standard mechanism of integration of different types of data into unified data models, has facilitated the deployment of modern EMR. Also, a shift in paradigm due to recent technological revolutions such as the development of the World Wide Web and the concepts of portal servers for accessing data for multiple sources has significantly boosted the trends into open systems which allows easier and more functional integration of medical data from different sources. Furthermore, the emergence of a new strategy for software development, based on open source components, allows software programs to be shared and exchanged between different institutions leading to more rapid deployment of standardized electronic patient record. Copyright 2002 Elsevier Science Ltd.